Healthcare Provider Details

I. General information

NPI: 1194273052
Provider Name (Legal Business Name): MARGARITA E MATAMOROS LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD STE 630
BETHESDA MD
20817-1106
US

IV. Provider business mailing address

512 CAROUSEL CT
GAITHERSBURG MD
20877-3486
US

V. Phone/Fax

Practice location:
  • Phone: 240-449-3094
  • Fax:
Mailing address:
  • Phone: 301-367-1584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15548
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: